A client has a sodium level of 121 mEq/L. What is the priority nursing intervention?

Choice A reason: A 30-pack-year smoking history indicates COPD risk but not acute distress. Smoking is a chronic factor, not an immediate symptom requiring urgent assessment. Clients with active respiratory distress, like accessory muscle use, take priority due to immediate risks of hypoxia.

Choice B reason: A 52-year-old in a tripod position using accessory muscles indicates severe respiratory distress in COPD, reflecting hypoxia or hypercapnia. This posture and muscle use signal increased work of breathing, requiring immediate assessment to prevent respiratory failure, making this client the highest priority.

Choice C reason: Dependent edema and clubbed fingers in a 68-year-old suggest chronic COPD with possible cor pulmonale. These are chronic findings, not acute distress. Clients with immediate respiratory compromise, like accessory muscle use, take priority due to the risk of rapid decompensation.

Choice D reason: Chronic cough with thick secretions is common in COPD but less urgent than acute respiratory distress. Secretions contribute to airway obstruction, but tripod positioning and accessory muscle use indicate immediate hypoxia risk, requiring priority assessment over chronic symptoms.

Choice A reason: Hypovolemia is likely, as vomiting and diarrhea cause significant fluid loss, leading to dehydration. Confusion (from cerebral hypoperfusion), elevated temperature (from concentrated blood), and dry mouth (from reduced saliva) reflect low intravascular volume, making this the most fitting diagnosis for the client’s condition.

Choice B reason: Hypernatremia results from excessive sodium relative to water, often from inadequate water intake. Vomiting and diarrhea deplete water and electrolytes, causing hypovolemia, not sodium excess. Confusion and fever align with dehydration, making hypernatremia an incorrect diagnosis in this scenario.

Choice C reason: Hypokalemia may occur with diarrhea due to potassium loss, but confusion, fever, and dry mouth primarily reflect hypovolemia from fluid loss. Potassium loss is secondary, as hypovolemia’s systemic effects are more immediate, making this a less comprehensive diagnosis for the client’s symptoms.

Choice D reason: Metabolic acidosis can occur with diarrhea due to bicarbonate loss, but confusion, fever, and dry mouth primarily reflect hypovolemia from fluid loss. Acidosis may contribute, but hypovolemia drives these systemic signs, making it the more accurate diagnosis in this context.